=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831165802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPE FEAR CARDIOLOGY ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2006
-----------------------------------------------------
Last Update Date | 01/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3634 CAPE CENTER DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-485-6470
-----------------------------------------------------
Fax | 910-485-8198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3634 CAPE CENTER DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-485-6470
-----------------------------------------------------
Fax | 910-485-8198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | THOR E KLANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 910-485-6470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------